HELLP syndrome complicated by liver rupture – case report

Czech version

Authors: M. Součková ⁴; R. Pilka ¹; T. Malý ²; M. Procházka ¹; J. Frančáková ³; V. Lattová ¹; K. Horváthová ¹
Authors‘ workplace: Gynekologicko-porodnická klinika FN a LF UP, Olomouc, přednosta prof. MUDr. R. Pilka. Ph. D. ¹; I. chirurgická klinika FN a LF UP, Olomouc, přednosta doc. MUDr. Č. Neoral, CSc. ²; Klinika anesteziologie, resuscitace a intenzivní medicíny FN a LF UP, Olomouc, přednosta doc. MUDr. M. Adamus, Ph. D. ³; Gynekologicko-porodnické oddělení nemocnice, Vyškov, příspěvková organizace, přednosta prim. MUDr. J. Eim ⁴
Published in: Ceska Gynekol 2014; 79(3): 219-225

Overview

Objective:
A case of HELLP syndrome complicated by liver rupture in the 36th week of pregnancy.

Designs:
A case report.

Setting:
Department of Obstetrics and Gynaecology, FN Olomouc.

Case report:
The authors report a case of 31 years old female patient who came to the hospital at 36th week of pregnancy with epigastric pain lasting about 14 days. The problems became worse in the last 10 hours. At admission, the patient was pale with repeatedly unmeasurable blood pressure, and she had lower limbs oedema. There was performed the caesarian section, during the operation the liver rupture was found. Both, patient and her baby, was saved thanks to the concerted interdisciplinary team work.

Conclusion:
One of the most serious complications of HELLP syndrome is liver rupture. It occurs in 3.8% of HELLP syndrome cases. The solution of this complication is to perform an acute operation. The operation is based on liver suture with application of deep mattress suture, applying hemostatic materials, liver compression by Mikulicz´s tamponade or ligation of liver artery. There is also possibility to use omentoplasty. If there is necessity of liver resection for necrotic focus, the argon coagulative laser is used preferably.

Keywords:
HELLP syndrome, liver rupture, diaphragm rupture

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